1
|
Bertalan G, Duparc R, Krepuska M, Toth D, Madjidyar J, Thurner P, Schubert T, Kulcsar Z. Dynamic Perviousness Predicts Revascularization Success in Acute Ischemic Stroke. Diagnostics (Basel) 2024; 14:535. [PMID: 38473007 DOI: 10.3390/diagnostics14050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The predictive value of thrombus perviousness in acute ischemic stroke (AIS), as measured by computed tomography (CT), has been intensively studied with conflicting results. In this study, we investigate the predictive potential of the novel concept of dynamic perviousness using three-dimensional (3D) volumetric evaluation of occlusive thrombi. METHODS The full thrombus volume in 65 patients with a hyperdense artery sign on non-contrast CT (NCCT), who underwent mechanical thrombectomy (MT), was segmented. Perviousness maps were computed voxel-wise for the entire thrombus volume as thrombus attenuation increase (TAI) between NCCT and CT angiography (CTA) as well as between CTA and late venous phase CT (CTV). Perviousness was analyzed for its association with NIHSS at admission, Thrombolysis In Cerebral Infarction (TICI) score, and number of MT passes. RESULTS The mean late-uptake TAI of thrombi with NIHSS scores greater than 21 at admission was approximately 100% higher than for lower scored NIHSS (p between 0.05 and 0.005). Concerning revascularization results, thrombi requiring less than four MT passes had ca. 80% higher group mean late-uptake TAI than clots requiring four or more passes (p = 0.03), and thrombi with TICI score III had ca. 95% higher group mean late-uptake TAI than thrombi with TICI II (p = 0.03). Standard perviousness showed no significant correlation with MT results. CONCLUSION Standard thrombus perviousness of 3D clot volume is not associated with revascularization results in AIS. In contrast, dynamic perviousness assessed with a voxel-wise characterization of 3D thrombi volume may be a better predictor of MT outcomes than standard perviousness.
Collapse
Affiliation(s)
- Gergely Bertalan
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Roxane Duparc
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Miklos Krepuska
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Daniel Toth
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| |
Collapse
|
2
|
Kamepalli HK, Kannath SK, Sylaja PN, Rajan JE, Chandrasekharan K. Thrombus Attenuation Gradient Can Predict Successful First-Pass Recanalization Following Stentriever Thrombectomy. World Neurosurg 2024; 181:e780-e788. [PMID: 37925151 DOI: 10.1016/j.wneu.2023.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Computed tomography angiography (CTA) derived thrombus enhancement characteristics can predict first-pass recanalization. We studied whether dynamic contrast kinetics within the clot in multiphase CTA can predict first-pass recanalization following stentriever thrombectomy. METHODS Patients with acute large vessel occlusive stroke evaluated with multiphasic CTA who underwent stentriever thrombectomy were selected. Thrombus perviousness on various phases including arterial, venous, and delayed phases was calculated. Thrombus attenuation gradient (TAG), defined as average attenuation difference between adjacent phases, was also evaluated and correlated with successful first-pass outcome (modified Treatment in Cerebral Ischemia score ≥2b). RESULTS Of 69 patients, 32 (47%) had successful first-pass recanalization (group 1), and 37 (53%) required >1 attempt (group 2). TAG showed significant differences in arterial-plain and venous-arterial phases. The early increase in TAG was seen in group 1 in the arterial-plain phase, as opposed to group 2 (12.6 vs. 9, P = 0.01), which plateaued in the venous-arterial phase for group 1 and showed a further increase in group 2 (2.1 vs. 5.1, P = 0.02). A cutoff value of 9.2 HU for arterial-plain phase (P = 0.001) and 4.2 HU (P = 0.001) for venous-arterial phase was predictive of first-pass effect. Combining 2 metrics had an odds ratio of 2.8 for first-pass recanalization (P = 0.035). Accuracy evaluated in a validation cohort yielded 74%. Other features including histology were not significant. CONCLUSIONS TAG evaluated from multiphase CTA can predict first-pass effect in stentriever thrombectomy.
Collapse
Affiliation(s)
- Hari Kishore Kamepalli
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Santhosh Kumar Kannath
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - P N Sylaja
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jayadevan Enakshy Rajan
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Kesavadas Chandrasekharan
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
3
|
Negative susceptibility vessel sign might be predictive of complete reperfusion in patients with acute basilar artery occlusion managed with thrombectomy. Eur Radiol 2023; 33:2593-2604. [PMID: 36562785 DOI: 10.1007/s00330-022-09215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Negative susceptibility vessel sign (SVS) on pre-thrombectomy MRI has been linked to fibrin-rich thrombus and difficult retrieval in anterior ischemic stroke. However, its impact in posterior circulation-large vessel occlusion stroke (PC-LVOS) has not yet been elucidated. We aim to investigate the relationship of SVS parameters with stroke subtypes and their influence on angiographic and functional outcomes. METHODS Prospective thrombectomy registries at two-comprehensive stroke centers were retrospectively reviewed between January 2015 and December 2019 for consecutive MRI-selected patients with PC-LVOS. Two groups were assigned by two independent readers, based on the presence or absence of the SVS (SVS +, SVS -) on MRI-GRE sequence. Multivariate logistic regression analysis was utilized to study primarily the impact of the SVS on the rate of complete recanalization (defined as mTICI 2c/3) at the final series following endovascular thrombectomy (EVT) and whether or not it might influence the efficacy of the frontline EVT strategy. Secondarily, we studied whether the absence of the SVS was predictive of the rate of 90-day functional independence (defined as mRS score < 2). Lastly, both qualitative (SVS +, SVS-) and quantitative (SVS length and diameter) parameters of the SVS were analyzed in association with the puncture to recanalization interval and various stroke etiological subtypes based on TOAST criteria. RESULTS Among 1823 patients, 116 were qualified for final analysis (median age, 68 (59-75) years; male, 65%); SVS was detected in 62.9% (73/116) of cases. SVS length was an independent predictor of procedural duration (p = .01) whilst two-layered SVS was inversely associated with the atherosclerosis etiological subtype (aOR = 0.27, 95% CI 0.08-0.89; p = .03). Successful recanalization was achieved in 82% (60/73) vs. 86% (37/43), p = .80 of patients with SVS (+, -) respectively. Only in SVS (+), stentriever (RR 0.59 (0.4-0.88), p = .009), and contact-aspiration (RR 0.82 (0.7-0.96), p = .01) achieved a lower rate of successful recanalization compared to combined technique. SVS (-) was significantly associated with a higher rate of mTICI 2c/3 (aOR = 4.444; 95% CI 1.466-13.473; p = .008) and showed an indirect effect of 9% towards functional independence mediated by mTICI 2c/3. CONCLUSION SVS parameters in PC-LVOS might predict stroke subtype and indirectly influence the functional outcome by virtue of complete recanalization. KEY POINTS • Negative susceptibility vessel sign (SVS) in patients with basilar occlusion independently predict complete recanalization that indirectly instigated a 3-month favorable outcome following thrombectomy. • The longer the SVS, the higher likelihood of large artery atherosclerosis and the longer the thrombectomy procedure. • Two-layered SVS might be negatively associated with the presence of atherosclerosis, yet already-known limitations of TOAST classification and the absence of pathological analysis should be taken into consideration.
Collapse
|
4
|
Kanamoto T, Tateishi Y, Yamashita K, Furuta K, Torimura D, Tomita Y, Hirayama T, Shima T, Nagaoka A, Yoshimura S, Miyazaki T, Ideguchi R, Morikawa M, Morofuji Y, Horie N, Izumo T, Tsujino A. Impact of width of susceptibility vessel sign on recanalization following endovascular therapy. J Neurol Sci 2023; 446:120583. [PMID: 36827810 DOI: 10.1016/j.jns.2023.120583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the relationship between arterial recanalization following endovascular therapy and the susceptibility vessel sign (SVS) length and width on susceptibility-weighted imaging. METHODS We retrospectively evaluated consecutive patients with anterior circulation ischemic stroke who underwent magnetic resonance imaging preceded endovascular therapy, and measured the SVS length and width. Successful recanalization was defined as expanded thrombolysis in cerebral infarction grade of 2b to 3. Logistic regression analysis was executed to determine the independent predictors of successful recanalization and first-pass reperfusion (FPR) after endovascular therapy. RESULTS Among 100 patients, successful recanalization and FPR were observed in 77 and 34 patients, respectively. The median SVS length and width were 10.3 mm (interquartile range, 6.8-14.1 mm) and 4.2 mm (interquartile range, 3.1-5.2 mm), respectively. In multivariate logistic regression analysis, SVS width was associated with successful recanalization (odds ratio, 1.88; 95% confidence interval, 1.14-3.07; p = 0.005) and FPR (odds ratio, 1.38; 95% confidence interval, 1.01-1.89; p = 0.039). The optimal cutoff value for the SVS width to predict successful recanalization and FPR were 4.2 mm and 4.0 mm, respectively. CONCLUSIONS Larger SVS width may predict successful recanalization and FPR following endovascular therapy.
Collapse
Affiliation(s)
- Tadashi Kanamoto
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Kairi Yamashita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Kanako Furuta
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Daishi Torimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Yuki Tomita
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Takuro Hirayama
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Tomoaki Shima
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Atsushi Nagaoka
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shunsuke Yoshimura
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Teiichiro Miyazaki
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Reiko Ideguchi
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; Department of Neurosurgery, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima 734-8551, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| |
Collapse
|
5
|
Hyperdense middle cerebral artery sign predicts favorable outcome in patients undergoing mechanical thrombectomy. J Thromb Thrombolysis 2023; 55:312-321. [PMID: 36434302 DOI: 10.1007/s11239-022-02731-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/26/2022]
Abstract
Non-contrast computer tomography detects the presence of hyperdense middle cerebral artery sign (HMCAS). Studies on the prognostic value of HMCAS among patients undergoing mechanical thrombectomy (MT) are conflicting. A retrospective analysis of consecutive patients with acute ischemic stroke due to middle cerebral artery occlusion, presenting with or without HMCAS, who underwent MT, was performed. We enrolled 191 patients (HMCAS +, n = 140; HMCAS -, n = 51). Prevalence of successful recanalization was significantly higher in patients with HMCAS than in those without HMCAS (92.1% versus 74.5%, p = 0.001). Patients with HMCAS had a better clinical outcome than those HMCAS - (54.3% versus 37.3%, p = 0.037, for three-month favorable outcome; 62.9% versus 39.3%, p = 0.004, for major neurological improvement at discharge; 8.6% versus 19.6%, p = 0.035, for in-hospital mortality; 14.3% versus 27.5%, p = 0.035, for intracranial hemorrhage; 2.9% versus 17.6%, p = 0.001, for symptomatic intracranial hemorrhage). Multivariate analyses confirmed that HMCAS represents an independent predictor of three-month favorable outcome (OR 2.48, 95% CI 1.10-5.58, p = 0.028), major neurological improvement at discharge (OR 2.40, 95% CI 1.09-5.20, p = 0.030), in-hospital mortality (OR 0.29, 95% CI 0.010-0.81, p = 0.018), presence of ICH (OR 0.49, 95% CI 0.25-0.97, p = 0.042) and presence of SICH (OR 0.16, 95% CI 0.04-0.63, p = 0.009). HMCAS presence predicts favorable outcome in patients undergoing MT. This result may indicate that hyperdense clots are more likely to respond to MT than isodense ones. This effect is mediated by reduction in hemorrhagic transformation.
Collapse
|
6
|
Thrombus magnetic susceptibility is associated with recanalization and clinical outcome in patients with ischemic stroke. Neuroimage Clin 2022; 36:103183. [PMID: 36095890 PMCID: PMC9472059 DOI: 10.1016/j.nicl.2022.103183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
In acute ischemic stroke patients with large vessel occlusion, the characteristics of the occluding thrombus on neuroimaging may be associated with recanalization after endovascular thrombectomy (EVT); however, the relationship between magnetic susceptibility of thrombus and clinical outcome remains unclear. We utilized quantitative susceptibility mapping (QSM) MRI to assess the magnetic susceptibility of thrombus in acute ischemic stroke patients undergoing EVT, and to evaluate its relationship with recanalization and functional outcomes. Patients with documented intracranial artery occlusion were consecutively recruited from one research center of the RESCUE-RE study (a registration study for Critical Care of Acute Ischemic Stroke After Recanalization). All the recruited patients underwent a 3D multi-echo MRI scan on a 3.0 T scanner for both susceptibility-weighted imaging (SWI) and QSM quantification of the thrombus. Among 61 patients included in the analyses, 51 (75.0 %) patients achieved thrombolysis in cerebral infarction (TICI) 2b/3 and 22 (36.1 %) patients had favorable functional outcomes. Successful recanalization was significantly associated with a higher thrombus magnetic susceptibility mean value (0.27 ± 0.09 vs 0.20 ± 0.09 ppm, p = 0.020) and lower coefficient of variation (0.42 ± 0.12 vs 0.52 ± 0.19, p = 0.024). ROC curve analysis showed the optimal cutoff value for thrombus susceptibility for predicting good clinical outcomes was 0.25 ppm (sensitivity 86.4 %, specificity 69.2 %). In multivariable logistic regression analyses, increased thrombus magnetic susceptibility was independently and significantly associated with good functional outcomes (adjusted odds ratio 15.11 [95 % confidence interval 2.64-86.46], p = 0.002). This study demonstrated that the increased thrombus magnetic susceptibility is associated with successful recanalization and favorable functional outcomes for intracranial artery occluded stroke patients.
Collapse
|
7
|
Patil S, Darcourt J, Messina P, Bozsak F, Cognard C, Doyle K. Characterising acute ischaemic stroke thrombi: insights from histology, imaging and emerging impedance-based technologies. Stroke Vasc Neurol 2022; 7:353-363. [PMID: 35241632 PMCID: PMC9453827 DOI: 10.1136/svn-2021-001038] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment of acute ischaemic stroke (AIS) focuses on rapid recanalisation of the occluded artery. In recent years, advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure. Despite ongoing developments and progress in AIS imaging techniques, it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment. Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients. In this review, what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined. This review also discusses the evidence that AIS thrombus composition varies with aetiology, questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment. Furthermore, this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition. Further use of new emerging technologies based on bioimpedance, as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced. Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.
Collapse
Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland .,Physiology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
8
|
Yamamoto Y, Yamamoto N, Kanematsu Y, Yamaguchi I, Ishihara M, Miyamoto T, Sogabe S, Shimada K, Takagi Y, Izumi Y. The claw sign predicts first-pass effect in mechanical thrombectomy for cerebral large vessel occlusion in the anterior circulation. Surg Neurol Int 2022; 13:72. [PMID: 35242438 PMCID: PMC8888293 DOI: 10.25259/sni_1160_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/09/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Mechanical thrombectomy (MT) is an effective treatment for acute cerebral large vessel occlusion (LVO). Complete recanalization of vessels in a single procedure is defined as the first-pass effect (FPE) and is associated with good prognosis. In this study, angiographic clot protruding sign termed the “claw sign,” was examined as candidate preoperative imaging factor for predicting the FPE.
Methods:
We retrospectively analyzed data from 91 consecutive patients treated for acute LVO in the anterior circulation by MT between January 2014 and December 2019. The claw sign was defined as a thrombus that protruded proximally by more than half of the diameter of the parent artery. Radiological findings such as claw sign, clinical and etiological features, and outcomes were compared between groups with and without successful FPE. Multivariate analysis was conducted to evaluate perioperative factors associated with FPE.
Results:
FPE was achieved in 26 of 91 (28.6%) patients and the claw sign was observed in 34 of 91 (37.4%) patients. The claw sign was significantly more frequent in the successful FPE group than in the failed FPE group (53.8% vs. 30.8%; P = 0.040). After the multivariate analysis, the claw sign was the only pretreatment parameter that could predict FPE (odds ratio, 2.67; 95% confidence interval, 1.01–7.06; P = 0.047).
Conclusion:
The claw sign is an angiographic imaging factor that might predict FPE after MT for anterior circulation acute ischemic stroke.
Collapse
Affiliation(s)
- Yuki Yamamoto
- Departments of Clinical Neuroscience, Tokushima University, Tokushima, Japan,
| | - Nobuaki Yamamoto
- Departments of Clinical Neuroscience, Tokushima University, Tokushima, Japan,
| | | | | | | | | | - Shu Sogabe
- Neurosurgery, Tokushima University, Tokushima, Japan
| | - Kenji Shimada
- Neurosurgery, Tokushima University, Tokushima, Japan
| | | | - Yuishin Izumi
- Departments of Clinical Neuroscience, Tokushima University, Tokushima, Japan,
| |
Collapse
|
9
|
Kovilapu UB, Jain N, Mishra A, Malik V. Selecting the Appropriate First-Line Strategy Based on Hyperdense Vessel Sign in Acute Ischemic Stroke Increases First Pass Recanalization: A Tertiary Center Experience. Indian J Radiol Imaging 2022; 31:830-836. [PMID: 35136493 PMCID: PMC8817827 DOI: 10.1055/s-0041-1741095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background:
The data pertaining to selecting an optimal first-line strategy (stent retriever [SR] vs. contact aspiration [CA]) based on noncontrast computed tomography (NCCT) in cases of acute ischemic stroke consequent to large vessel occlusion (LVO) is lacking.
Aims:
This article studies the influence of hyperdense vessel sign (HVS) in selecting optimal first-line strategy, with intention of increasing first-pass recanalization (FPR).
Methods:
Upfront approach at our center is SR technique with rescue therapy (CA) adoption consequent to three failed SR attempts to achieve successful recanalization. Data of patients with acute LVO who underwent mechanical thrombectomy from June 2017 to May 2020 was retrospectively analyzed. Patients were classified into HVS (+) and HVS (−) cohort. Rate of successful recanalization (first pass, early, and final) and efficacy of rescue therapy was assessed between the two cohorts.
Results:
Of 52 patients included, 28 and 24 were assigned to the HVS (+) and HVS (−) cohort, respectively. FPR was observed in 50% of HVS (+) and 20.9% of HVS (−) (
p
= 0.029). Early recanalization was documented in 64.2% of HVS (+) and 37.5% of HVS (−) (
p
= 0.054). Rescue therapy need was higher in patients not demonstrating HVS (
p
= 0.062). Successful recanalization was achieved with rescue therapy in 50% of HVS (−) group.
Conclusion:
A higher FPR is achievable following individualized first-pass strategy (based on NCCT appearance of clot), instead of a generalized SR first-pass approach. This CT imaging-based strategy is a step closer to achieving primary angiographic goal of FPR.
Collapse
Affiliation(s)
- Uday Bhanu Kovilapu
- Interventional Radiologist at Department of Radiodiagnosis and Interventional Radiology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Narendra Jain
- Interventional Radiologist at Department of Radiodiagnosis and Interventional Radiology, Command Hospital, Chandi Mandir, Haryana, India
| | - Atul Mishra
- Interventional Radiologist at Department of Radiodiagnosis and Interventional Radiology, Army Hospital (R&R), New Delhi, India
| | - Virender Malik
- Interventional Radiologist at Department of Radiodiagnosis and Interventional Radiology, Army Institute of Cardiothoracic sciences (AICTS), affiliated to Armed Forces Medical College, Pune, Maharashtra, India
| |
Collapse
|
10
|
Belachew NF, Piechowiak EI, Dobrocky T, Meinel TR, Hakim A, Barvulsky EA, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Fischer U, Gralla J, Kaesmacher J, Mordasini P. Stent-Based Retrieval Techniques in Acute Ischemic Stroke Patients with and Without Susceptibility Vessel Sign. Clin Neuroradiol 2022; 32:407-418. [PMID: 34463776 PMCID: PMC9187552 DOI: 10.1007/s00062-021-01079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Randomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status. METHODS We retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI). RESULTS An SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491-6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752-13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results. CONCLUSION While previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status.
Collapse
Affiliation(s)
- Nebiyat F. Belachew
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Eike I. Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Thomas R. Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Enrique A. Barvulsky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Jan Vynckier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland ,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| |
Collapse
|
11
|
Susceptibility vessel sign as a predictor for recanalization and clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis. J Clin Neurosci 2021; 94:159-165. [PMID: 34863431 DOI: 10.1016/j.jocn.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/04/2021] [Accepted: 10/14/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prognostic values of susceptibility vessel sign (SVS) on T2*-weighted MRI using GRE and SWI sequences for recanalization status and clinical outcomes in patients with acute ischaemic stroke undergoing different therapies. METHODS Literature search on PubMed, EMBASE databases and other sources from inception up to 01 June 2021 was conducted. 11 studies which reported SVS, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. RESULTS Pooled analysis demonstrated significant association between good clinical outcome and SVS-positive patients who underwent mechanical thrombectomy (RR = 1.34, 95% CI = 1.07-1.67, p = 0.01), which is in line with higher recanalization rate in SVS-positive patients who were treated with mechanical thrombectomy compared to intravenous thrombolysis only. No statistically significant association was demonstrated between presence of SVS and successful recanalization, likely due to limitations in the recruited studies. CONCLUSIONS Presence of SVS in patients with acute ischaemic stroke who underwent mechanical thrombectomy is associated with good clinical outcome. SVS-positive patients treated with mechanical thrombectomy also shows better recanalization rate comparing to intravenous thrombolysis only, although not statistically significant. MRI assessment of the clot content using SVS is useful in selection of reperfusion strategy for acute ischaemic stroke and prognostication.
Collapse
|
12
|
Jing M, Yeo JYP, Holmin S, Andersson T, Arnberg F, Bhogal P, Yang C, Gopinathan A, Tu TM, Tan BYQ, Sia CH, Teoh HL, Paliwal PR, Chan BPL, Sharma V, Yeo LLL. Preprocedural Imaging : A Review of Different Radiological Factors Affecting the Outcome of Thrombectomy. Clin Neuroradiol 2021; 32:13-24. [PMID: 34709411 DOI: 10.1007/s00062-021-01095-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) has strong evidence for its effectiveness in treatment of acute ischemic stroke (AIS); however, up to half of the patients who undergo EVT still do not have good functional outcomes. Various prethrombectomy radiological factors have been shown to be associated with good clinical outcomes and may be the key to better functional outcomes, reduced complications, and reduced mortality. In this paper, we reviewed the current literature on these imaging parameters so they can be employed to better estimate the probability of procedural success, therefore allowing for more effective preprocedural planning of EVT strategies. We reviewed articles in the literature related to imaging factors which have been shown to be associated with EVT success. The factors which are reviewed in this paper included: anatomical factors such as 1) the type of aortic arch and its characteristics, 2) the characteristics of the thrombus such as length, clot burden, permeability, location, 3) the middle cerebral artery features including the tortuosity and underlying intracranial stenosis, 4) perfusion scans estimating the volume of infarct and the penumbra and 5) the effect of collaterals on the procedure. The prognostic effect of each factor on the successful outcome of EVT is described. The identification of preprocedural thrombectomy imaging factors can help to improve the chances of recanalization, functional outcomes, and mortality. It allows the interventionist to make time-sensitive decisions in the treatment of acute ischemic stroke.
Collapse
Affiliation(s)
- Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joshua Y P Yeo
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Tommy Andersson
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Paul Bhogal
- Department of Neuroradiology, St.Bartholomew's and the Royal London Hospital, London, UK
| | - Cunli Yang
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Benjamin Yong Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching Hui Sia
- National University Heart Centre, National University Health System, Singapore, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Prakash R Paliwal
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vijay Sharma
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore.
- Department of Clinical Neuroscience, Karolinska Institutet and Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
13
|
Belachew NF, Dobrocky T, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Piechowiak EI, Fischer U, Gralla J, Mordasini P, Kaesmacher J. Risks of Undersizing Stent Retriever Length Relative to Thrombus Length in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:2181-2187. [PMID: 34649917 DOI: 10.3174/ajnr.a7313] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Results regarding the association of thrombus length, stent retriever length, and recanalization success in patients with acute ischemic stroke are inconsistent. We hypothesized that the ratio of thrombus length to stent retriever length may be of particular relevance. MATERIALS AND METHODS Patients with acute ischemic stroke undergoing stent retriever thrombectomy at our institution between January 2010 and December 2018 were reviewed retrospectively. Thrombus length was assessed by measuring the susceptibility vessel sign on SWI using a 1.5T or 3T MR imaging scanner. Multivariable logistic regression models were used to determine the association between thrombus length, stent retriever length, and thrombus length/stent retriever length ratio with first-pass recanalization, overall recanalization, and embolization in new territories. Results are shown as adjusted ORs with 95% CIs. Additional mediation analyses were performed to test for indirect effects on first-pass recanalization and overall recanalization success. RESULTS The main analysis included 418 patients (mean age, 74.9 years). Increasing stent retriever length was associated with first-pass recanalization. Decreasing thrombus length and lower thrombus length/stent retriever length ratios were associated with first-pass recanalization and overall recanalization. Thrombus length and stent retriever length showed no association with first-pass recanalization or overall recanalization once thrombus length/stent retriever length ratio was factored in, while thrombus length/stent retriever length ratio remained a significant factor in both models (adjusted OR, 0.316 [95% CI, 0.112-0.892]; P = .030 and adjusted OR, = 0.366 [95% CI, 0.194-0.689]; P = .002). Mediation analyses showed that decreasing thrombus length and increasing stent retriever length had a significant indirect effect on first-pass recanalization mediated through thrombus length/stent retriever length ratio. The only parameter associated with embolization in new territories was an increasing thrombus length/stent retriever length ratio (adjusted OR, 5.079 [95% CI, 1.332-19.362]; P = .017). CONCLUSIONS Information about thrombus and stent length is more valuable when combined. High thrombus length/stent retriever length ratios, which may raise the risk of unsuccessful recanalization and embolization in new territories, should be avoided by adapting stent retriever selection to thrombus length whenever possible.
Collapse
Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - T R Meinel
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Vynckier
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - U Fischer
- Department of Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., A.H., R.W., E.I.P., J.G., P.M., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| |
Collapse
|
14
|
Belachew NF, Dobrocky T, Aleman EB, Meinel TR, Hakim A, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Mordasini P, Gralla J, Fischer U, Piechowiak EI, Kaesmacher J. SWI Susceptibility Vessel Sign in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1949-1955. [PMID: 34593377 DOI: 10.3174/ajnr.a7281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The frequency and clinical significance of the susceptibility vessel sign in patients with acute ischemic stroke remains unclear. We aimed to assess its prevalence in patients with acute ischemic stroke undergoing mechanical thrombectomy and to analyze its association with interventional and clinical outcome parameters in that group. MATERIALS AND METHODS Six hundred seventy-six patients with acute ischemic stroke and admission MR imaging were reviewed retrospectively. Of those, 577 met the eligibility criteria for further analysis. Imaging was performed using a 1.5T or 3T MR imaging scanner. Associations between baseline variables, interventional and clinical outcome parameters, and susceptibility vessel sign were determined with multivariable logistic regression models. Results are shown as adjusted ORs with 95% CIs. RESULTS The susceptibility vessel sign was present in 87.5% (n = 505) of patients and associated with tandem occlusion (adjusted OR, 3.3; 95% CI, 1.1-10.0; P = .032) as well as successful reperfusion, defined as an expanded TICI score of ≥2b (adjusted OR, 2.4; 95% CI, 1.28-4.6; P = .007). The susceptibility vessel sign was independently associated with functional independence (mRS ≤ 2: adjusted OR, 2.1; 95% CI, 1.1-4.0; P = .028) and lower mortality (adjusted OR, 0.4; 95% CI, 0.2-0.7; P = .003) at 90 days, even after adjusting for successful reperfusion. The susceptibility vessel sign did not influence the number of passes performed during mechanical thrombectomy, the first-pass reperfusion, or the risk of peri- or postinterventional complications. CONCLUSIONS The susceptibility vessel sign is an MR imaging phenomenon frequently observed in patients with acute ischemic stroke and is associated with successful reperfusion after mechanical thrombectomy. However, superior clinical functional outcome and lower mortality noted in patients showing the susceptibility vessel sign could not be entirely attributed to higher reperfusion rates.
Collapse
Affiliation(s)
- N F Belachew
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - T Dobrocky
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - E B Aleman
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - T R Meinel
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - A Hakim
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Vynckier
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - M Arnold
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - D J Seiffge
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - R Wiest
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - P Mordasini
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Gralla
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - U Fischer
- Neurology (T.R.M., J.V., M.A., D.J.S., U.F.)
| | - E I Piechowiak
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.)
| | - J Kaesmacher
- From the Departments of Diagnostic and Interventional Neuroradiology (N.F.B., T.D., E.B.A., A.H., R.W., P.M., J.G., E.I.P., J.K.).,Diagnostic, Interventional and Pediatric Radiology (J.K.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| |
Collapse
|
15
|
Guenego A, Fahed R, Sussman ES, Leipzig M, Albers GW, Martin BW, Marcellus DG, Kuraitis G, Marks MP, Lansberg MG, Wintermark M, Heit JJ. Impact of Clot Shape on Successful M1 Endovascular Reperfusion. Front Neurol 2021; 12:642877. [PMID: 33597919 PMCID: PMC7882685 DOI: 10.3389/fneur.2021.642877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: The susceptibility-vessel-sign (SVS) allows thrombus visualization, length estimation and composition, and it may impact reperfusion during mechanical thrombectomy (MT). SVS can also describe thrombus shape in the occluded artery: in the straight M1-segment (S-shaped), or in an angulated/traversing a bifurcation segment (A-shaped). We determined whether SVS clot shape influenced reperfusion and outcomes after MT for proximal middle-cerebral-artery (M1) occlusions. Methods: Between May 2015 and March 2018, consecutive patients who underwent MT at one comprehensive stroke center and who had a baseline MRI with a T2* sequence were included. Clinical, procedural and radiographic data, including clot shape on SVS [angulated/bifurcation (A-SVS) vs. straight (S-SVS)] and length were assessed. Primary outcome was successful reperfusion (TICI 2b-3). Secondary outcome were MT complication rates, MT reperfusion time, and clinical outcome at 90-days. Predictors of outcome were assessed with univariate and multivariate analyses. Results: A total of 62 patients were included. 56% (35/62) had an A-SVS. Clots were significantly longer in the A-SVS group (19 mm vs. 8 mm p = 0.0002). Groups were otherwise well-matched with regard to baseline characteristics. There was a significantly lower rate of successful reperfusion in the A-SVS cohort (83%) compared to the S-SVS cohort (96%) in multivariable analysis [OR 0.04 (95% CI, 0.002–0.58), p = 0.02]. There was no significant difference in long term clinical outcome between groups. Conclusion: Clot shape as determined on T2* imaging, in patients presenting with M1 occlusion appears to be a predictor of successful reperfusion after MT. Angulated and bifurcating clots are associated with poorer rates of successful reperfusion.
Collapse
Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Robert Fahed
- Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Eric S Sussman
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Matthew Leipzig
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Blake W Martin
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Gabriella Kuraitis
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Michael P Marks
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, Stanford, CA, United States
| |
Collapse
|
16
|
Darcourt J, Garcia C, Phuong DM, Michelozzi C, Bellanger G, Adam G, Roques M, Januel AC, Tall P, Albucher JF, Olivot JM, Bonneville F, Payrastre B, Cognard C. Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi. Int J Stroke 2021; 16:972-980. [PMID: 33435860 DOI: 10.1177/1747493020986626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The composition of the thrombus influences its retrievability by mechanical thrombectomy. PURPOSE Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition. METHODS This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVS+) or its negativity (SVS-) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining. RESULTS Histological analysis was performed on 102 clots. Thrombi with SVS- were significantly richer in fibrin/platelets, p = 0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases (n = 131). Clots retrieved combined therapy-rescue were richer in fibrin/platelets 63.9% versus 50.8% for aspiration first pass strategy, p = 0.03. Logistic regression analysis showed that fibrin/platelet-poor clots (<60%) were significantly more likely to be recanalized by aspiration first pass strategy compared to fibrin/platelet-rich clots (>60%) that were more likely recanalized by combined therapy-rescue after aspiration first pass strategy failure (OR = 3.5; 95% CI = 1.2-10.8; p = 0.0054). CONCLUSIONS Our results confirm that SVS- clots are rich in fibrin/platelets and suggest that these "white clots" are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.
Collapse
Affiliation(s)
- Jean Darcourt
- Department of Neuroradiology, CHU of Toulouse, France.,INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| | - Cédric Garcia
- INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France.,Laboratory of Hematology, CHU of Toulouse, France
| | | | | | | | - Gilles Adam
- Department of Neuroradiology, CHU of Toulouse, France
| | | | - Anne C Januel
- Department of Neuroradiology, CHU of Toulouse, France
| | - Philippe Tall
- Department of Neuroradiology, CHU of Toulouse, France
| | | | - Jean M Olivot
- Department of Vascular Neurology, CHU of Toulouse, France
| | | | - Bernard Payrastre
- INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France.,Laboratory of Hematology, CHU of Toulouse, France
| | - Christophe Cognard
- Department of Neuroradiology, CHU of Toulouse, France.,INSERM 333461I2MC (Institut des Maladies Cardiovasculaires et Métaboliques) UMR 1048, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
17
|
Mohammaden MH, Haussen DC, Perry da Camara C, Pisani L, Olive Gadea M, Al-Bayati AR, Liberato B, Rangaraju S, Frankel MR, Nogueira RG. Hyperdense vessel sign as a potential guide for the choice of stent retriever versus contact aspiration as first-line thrombectomy strategy. J Neurointerv Surg 2020; 13:599-604. [PMID: 32737205 DOI: 10.1136/neurintsurg-2020-016005] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The first-pass effect (FPE) has emerged as a key metric for efficacy in mechanical thrombectomy (MT). The hyperdense vessel sign (HDVS) on non-contrast head CT (NCCT) indicates a higher clot content of red blood cells. OBJECTIVE To assess whether the HDVS could serve as an imaging biomarker for guiding first-line device selection in MT. METHODS A prospective MT database was reviewed for consecutive patients with anterior circulation large vessel occlusion stroke who underwent thrombectomy with stent retriever (SR) or contact aspiration (CA) as first-line therapy between January 2012 and November 2018. Pretreatment NCCT scans were evaluated for the presence of HDVS. The primary outcome was FPE (modified Thrombolysis in Cerebral Infarction score 2c/3). The primary analysis was the interaction between HDVS and thrombectomy modality on FPE. Secondary analyses aimed to evaluate the predictors of FPE. RESULTS A total of 779 patients qualified for the analysis. HDVS and FPE were reported in 473 (60.7%) and 286 (36.7%) patients, respectively. The presence of HDVS significantly modified the effect of thrombectomy modality on FPE (p=0.01), with patients with HDVS having a significantly higher rate of FPE with a SR (41.3% vs 22.2%, p=0.001; adjusted OR 2.11 (95% CI 1.20 to 3.70), p=0.009) and non-HDVS patients having a numerically better response to CA (41.4% vs 33.9%, p=0.28; adjusted OR 0.58 (95% CI 0.311 to 1.084), p=0.088). Age (OR 1.01 (95% CI 1.00 to 1.02), p=0.04) and balloon guide catheter (OR 2.08 (95% CI 1.24 to 3.47), p=0.005) were independent predictors of FPE in the overall population. CONCLUSION Our data suggest that patients with HDVS may have a better response to SRs than CA for the FPE. Larger confirmatory prospective studies are warranted.
Collapse
Affiliation(s)
- Mahmoud H Mohammaden
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Catarina Perry da Camara
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Marta Olive Gadea
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Bernardo Liberato
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Srikant Rangaraju
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Michael R Frankel
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA .,Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| |
Collapse
|
18
|
Janot K, Zhu F, Kerleroux B, Boulouis G, Shotar E, Premat K, Eugene F, Dargazanli C, Chalumeau V, L'Allinec V, Benhassen W, Marnat G, Lebras A, Detraz L, Ognard J, Personnic T, Chivot C, Cappucci M, Forestier G, Soize S, Bourdain F, Consoli A, Labreuche J, Desal H, Lapergue B, Rouchaud A, Bourcier R. "Adaptative endovascular strategy to the CloT MRI in large intracranial vessel occlusion" (VECTOR): Study protocol of a randomized control trial. J Neuroradiol 2019; 47:382-385. [PMID: 31726072 DOI: 10.1016/j.neurad.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
A correlation between the susceptibility vessel sign (SVS) and red thrombi has been identified in MRI. We hypothesized that the Embotrap allow better retrieving of SVS+ thrombi. The AdaptatiVe Endovascular strategy to the CloT MRI in large intracranial vessel Occlusion (VECTOR) trial is a multicenter, prospective and randomized study designed to compare a first-line strategy combining Embotrap added to contact aspiration (CA) versus CA alone in patients with SVS+ occlusions.
Collapse
Affiliation(s)
- Kevin Janot
- Department of Neuroradiology, University Hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France.
| | | | - Basile Kerleroux
- Department of Neuroradiology, University Hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | | | | | | | | | | | | | | | | | | | | | - Lili Detraz
- University Hospital of Nantes, Nantes, France
| | | | | | | | | | | | | | | | | | - Julien Labreuche
- Department of Biostatistics, University Hospital of Lille, Lille, France
| | | | | | | | | | | |
Collapse
|
19
|
Li G, Wu G, Qin Z, Li H, Cheng X, Cai Y. Prognostic Value of Clot Burden Score in Acute Ischemic Stroke after Reperfusion Therapies: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:104293. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/12/2019] [Accepted: 07/10/2019] [Indexed: 01/08/2023] Open
|
20
|
Bacigaluppi M, Semerano A, Gullotta GS, Strambo D. Insights from thrombi retrieved in stroke due to large vessel occlusion. J Cereb Blood Flow Metab 2019; 39:1433-1451. [PMID: 31213164 PMCID: PMC6681524 DOI: 10.1177/0271678x19856131] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The recent advances of endovascular procedures to treat stroke due to large cerebral vessel occlusion have made it possible to analyze the retrieved thrombus material. Analysis of cerebral thrombi is emerging as a relevant opportunity to complement the diagnostic workup of etiology, to develop new lytic approaches and to optimize the acute treatment of stroke due to large vessel occlusion. Nonetheless, retrieved thrombi are frequently discarded since their informative potential is often neglected and standards are missing. This review provides an overview of the current knowledge and expanding research relating to thrombus composition analysis in large vessel occlusions. We first discuss the heterogeneity of thrombogenic factors that underlie the thrombotic formation in stroke and its implications to identify stroke etiology and thrombus age. Further, we show that understanding structural characteristics of thrombus is pivotal for the development of new-targeted lytic therapies as well as to improve, through thrombus modeling, the development of thrombectomy devices. Finally, we discuss the on-going attempts to identify a signature of thrombus composition indirectly through imaging and peripheral blood biomarkers, which might in future assist treatment decision-making as well as secondary prevention. Thrombus analysis might contribute to the advancement and optimization of personalized stroke treatments.
Collapse
Affiliation(s)
- Marco Bacigaluppi
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Aurora Semerano
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Giorgia Serena Gullotta
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Davide Strambo
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy.,2 Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
21
|
Aoki J, Suzuki K, Kanamaru T, Kutsuna A, Katano T, Takayama Y, Nishi Y, Takeshi Y, Nakagami T, Numao S, Abe A, Suda S, Nishiyama Y, Kimura K. Association between initial NIHSS score and recanalization rate after endovascular thrombectomy. J Neurol Sci 2019; 403:127-132. [DOI: 10.1016/j.jns.2019.06.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 11/15/2022]
|
22
|
Yamamoto Y, Yamamoto N, Kanematsu Y, Korai M, Shimada K, Izumi Y, Takagi Y. The Claw Sign: An angiographic Predictor of Recanalization After Mechanical Thrombectomy for Cerebral Large Vessel Occlusion. J Stroke Cerebrovasc Dis 2019; 28:1555-1560. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/18/2019] [Accepted: 03/01/2019] [Indexed: 01/05/2023] Open
|
23
|
Fitzgerald S, Mereuta OM, Doyle KM, Dai D, Kadirvel R, Kallmes DF, Brinjikji W. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome. J Neurosurg Sci 2019; 63:292-300. [PMID: 30514073 PMCID: PMC8693286 DOI: 10.23736/s0390-5616.18.04629-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Mechanical thrombectomy has become the stand of care for patients with large vessel occlusions, yet major improvements in thrombectomy speed, efficacy, and completeness can still be achieved. High rates of clot fragmentation and failure to remove the clot resulting in poor neurological outcomes suggest that in order to further advance the field of stroke intervention we must turn our attention towards understanding the science of clot. Accurately identifying the composition of the occlusive clot prior to intervention could significantly influence the success of the revascularization strategy used to treat them. Numerous features of thromboemboli could be studied and characterized, including quantitative histomorphometry and diagnostic imaging characteristics. Each of these features might logically predict superior thrombectomy outcomes with one device or another. This article aims to review the current literature on histopathological composition of acute ischemic stroke clots, with a particular focus on the correlation between clot composition and diagnostic imaging, stroke etiology and revascularization outcomes.
Collapse
Affiliation(s)
- Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Oana M Mereuta
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Karen M Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA -
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
24
|
Letter by Sporns et al Regarding Article, “Predictive Value of Susceptibility Vessel Sign for Arterial Recanalization and Clinical Improvement in Ischemic Stroke”. Stroke 2019; 50:e134. [DOI: 10.1161/strokeaha.119.024827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
25
|
Yeo LLL, Bhogal P, Gopinathan A, Cunli Y, Tan B, Andersson T. Why Does Mechanical Thrombectomy in Large Vessel Occlusion Sometimes Fail? Clin Neuroradiol 2019; 29:401-414. [DOI: 10.1007/s00062-019-00777-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
|
26
|
Chung JW, Kim YC, Cha J, Choi EH, Kim BM, Seo WK, Kim GM, Bang OY. Characterization of clot composition in acute cerebral infarct using machine learning techniques. Ann Clin Transl Neurol 2019; 6:739-747. [PMID: 31019998 PMCID: PMC6469248 DOI: 10.1002/acn3.751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 01/01/2023] Open
Abstract
Objective Clot characteristics can provide information on the cause of cerebral artery occlusion and may guide acute revascularization and secondary prevention strategies. We developed a rapid automated clot analysis system using machine learning (ML) and validated its accuracy in patients undergoing endovascular treatment. Methods Pre‐endovascular treatment gradient echo (GRE) images from consecutive patients with middle cerebral artery occlusion were utilized to develop and validate an ML system to predict whether atrial fibrillation (AF) was the underlying cause of ischemic stroke. The accuracy of the ML algorithm was compared with that of visual inspection by neuroimaging specialists for the presence of blooming artifact. Endovascular procedures and outcomes were compared in patients with and without AF. Results Of 67 patients, 29 (43.3%) had AF. Of these, 13 had known AF and 16 were newly diagnosed with cardiac monitoring. By visual inspection, interrater correlation for blooming artifact was 0.73 and sensitivity and specificity for AF were 0.79 and 0.63, respectively. For AF classification, the ML algorithms yielded an average accuracy of > 75.4% in fivefold cross‐validation with clot signal profiles obtained from 52 patients and an area under the curve >0.87 for the average AF probability from five signal profiles in external validation (n = 15). Analysis with an in‐house interface took approximately 3 min per patient. Absence of AF was associated with increased number of passes by stentriever, high reocclusion frequency, and additional use of rescue stenting and/or glycogen IIb/IIIa blocker for recanalization. Interpretation ML‐based rapid clot analysis is feasible and can identify AF with high accuracy, enabling selection of endovascular treatment strategy.
Collapse
Affiliation(s)
- Jong-Won Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Yoon-Chul Kim
- Clinical Research Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jihoon Cha
- Department of Radiology Yonsei University Medical Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Eun-Hyeok Choi
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Byung Moon Kim
- Department of Radiology Yonsei University Medical Center Yonsei University College of Medicine Seoul Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| |
Collapse
|
27
|
Byun JS, Nicholson P, Hilditch CA, Chun On Tsang A, Mendes Pereira V, Krings T, Fang Y, Brinjikji W. Thrombus perviousness is not associated with first-pass revascularization using stent retrievers. Interv Neuroradiol 2019; 25:285-290. [PMID: 30714501 DOI: 10.1177/1591019918825444] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent studies suggest that thrombus imaging characteristics such as Hounsfield unit (HU) and perviousness assessed on noncontrast computed tomography (NCCT) and CT angiography (CTA) can predict successful recanalization. We assessed whether these thrombus imaging characteristics could predict successful first-pass recanalization. METHODS We retrospectively reviewed cases of mechanical thrombectomy over a three-year period in which patients received a multiphase CTA and were treated with a stent retriever on first pass. Thrombus attenuation, thrombus enhancement on arterial- and delayed-phase CTA and percentage washout were calculated and their association with first-pass recanalization, successful recanalization and distal embolic complications was studied. RESULTS Fifty-two mechanical thrombectomy patients were included. First-pass recanalization was achieved in 59.6% and complete revascularization (Thrombolysis in Cerebral Infarction scale 2b/3) was achieved in 84.6%. There was no correlation between first-pass recanalization with thrombus density on NCCT ( p = 0.94), percentage enhancement on arterial ( p = 0.61) and delayed-phase CTA ( p = 0.23) or thrombus length ( p = 0.16). There was no correlation between number of passes and either thrombus density on NCCT ( p = 0.91) or percentage enhancement on arterial- ( p = 0.79) and delayed-phase ( p = 0.14) CTA or thrombus length ( p = 0.34). Clot length was significantly higher in patients with distal embolic complications than in those without (18.5 ± 7.9 vs 11.4 ± 6.6 mm, p = 0.005). CONCLUSIONS Our data suggest that thrombus imaging characteristics on multiphase CTA cannot predict first-pass recanalization or successful revascularization in acute ischemic stroke patients treated with stent retrievers. Longer clot length was associated with higher risk of distal embolic complications.
Collapse
Affiliation(s)
- Jun-Soo Byun
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Canada
| | - Patrick Nicholson
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Canada
| | | | | | | | - Timo Krings
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Canada
| | - Yibin Fang
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Canada
| | - Waleed Brinjikji
- Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Canada
| |
Collapse
|
28
|
Assessment of collateral blood flow in patients with distal branch occlusion of the middle cerebral artery. J Neuroradiol 2019; 46:3-8. [DOI: 10.1016/j.neurad.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 06/25/2018] [Accepted: 09/04/2018] [Indexed: 11/20/2022]
|
29
|
Darcourt J, Withayasuk P, Vukasinovic I, Michelozzi C, Bellanger G, Guenego A, Adam G, Roques M, Januel AC, Tall P, Meyrignac O, Rousseau V, Garcia C, Albucher JF, Payrastre B, Bonneville F, Olivot JM, Cognard C. Predictive Value of Susceptibility Vessel Sign for Arterial Recanalization and Clinical Improvement in Ischemic Stroke. Stroke 2019; 50:512-515. [DOI: 10.1161/strokeaha.118.022912] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jean Darcourt
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
- INSERM, U1048 and Université Toulouse 3, I2MC, France (J.D., C.G., J.F.A., B.P., C.C.)
| | | | - Ivan Vukasinovic
- Department of Neuroradiology, University Hospital Clinical Center of Serbia, Belgrade (I.V.)
| | - Caterina Michelozzi
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Guillaume Bellanger
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Adrien Guenego
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Gilles Adam
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Margaux Roques
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Anne Christine Januel
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Philippe Tall
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Olivier Meyrignac
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | | | - Cédric Garcia
- INSERM, U1048 and Université Toulouse 3, I2MC, France (J.D., C.G., J.F.A., B.P., C.C.)
| | | | - Bernard Payrastre
- INSERM, U1048 and Université Toulouse 3, I2MC, France (J.D., C.G., J.F.A., B.P., C.C.)
| | - Fabrice Bonneville
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
| | - Jean Marc Olivot
- Departement of Vascular Neurology (J.M.O.), CHU de Toulouse, France
| | - Christophe Cognard
- From the Departement of Neuroradiology (J.D., C.M., G.B., A.G., G.A., M.R., A.C.J., P.T., O.M., F.B., C.C.), CHU de Toulouse, France
- INSERM, U1048 and Université Toulouse 3, I2MC, France (J.D., C.G., J.F.A., B.P., C.C.)
| |
Collapse
|
30
|
Liu M, Li L, Li G. The different clinical value of susceptibility vessel sign in acute ischemic stroke patients under different interventional therapy: A systematic review and meta-analysis. J Clin Neurosci 2019; 62:72-79. [PMID: 30712778 DOI: 10.1016/j.jocn.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/08/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
Acute ischemic stroke (AIS) subtype, one of the most important factors for selecting therapeutic strategies, is difficult to be accurately diagnosed at admission sometimes. The magnetic susceptibility effect of deoxygenated hemoglobin in red thrombi appeared as hypointense signals in magnetic resonance imaging (MRI) scans. The prognostic value of susceptibility vessel sign (SVS) for stroke subtype, recanalization and outcomes in AIS patients will be comprehensively determined in the present study. A comprehensive search of databases was conducted including the PubMed, Embase, and Cochrane Library from inception up to August 2017. Statistical tests were performed to check for heterogeneity and publication bias. Subgroup and sensitivity analysis were also conducted to evaluate the robustness of the conclusions. Overall, 21 studies including 1832 patients were identified. The presence of SVS was significantly associated with cardioembolic stroke than absence of SVS (RR = 1.53, 95% CI = 1.30-1.81, p < 0.001). The patients with SVS were less likely to achieve recanalization (RR = 0.70, 95% CI = 0.56-0.88, p = 0.002) and poor functional outcome (RR = 1.68, 95% CI = 1.44-1.97, p < 0.001) after intravenous thrombolysis (IVT), whereas it was similar between two group after endovascular treatment (EVT) (p = 0.990 and p = 0.335). The SVS length was smaller in recanalization group than that in non-recanalization group (RR = -0.49, 95% CI = -0.72 to -0.27, p < 0.001), however, no significant difference between SVS width and recanalization rate was found. The presence of SVS appears to be a stronger predictor of cardioembolic stroke. Furthermore, the SVS was associated with a decreasing recanalization rate and poor outcome in AIS patients after IVT but not after EVT. Which offered a practical information to select optimal therapeutic strategies for stroke patients with SVS though the level of evidence seems to be quite shaky.
Collapse
Affiliation(s)
- Mingsu Liu
- Department of Neurology, The First Affiliated Hospital of ChongQing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Lin Li
- Department of Neurology, The First Affiliated Hospital of ChongQing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Guangqin Li
- Department of Neurology, The First Affiliated Hospital of ChongQing Medical University, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing, China.
| |
Collapse
|
31
|
Derraz I, Bourcier R, Soudant M, Soize S, Hassen WB, Hossu G, Clarencon F, Derelle AL, Tisserand M, Raoult H, Legrand L, Bracard S, Oppenheim C, Naggara O. Does Clot Burden Score on Baseline T2*-MRI Impact Clinical Outcome in Acute Ischemic Stroke Treated with Mechanical Thrombectomy? J Stroke 2019; 21:91-100. [PMID: 30732444 PMCID: PMC6372898 DOI: 10.5853/jos.2018.01921] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose A long clot, defined by a low (0-6) clot burden score (CBS) assessed by T2*-MR sequence, is associated with worse clinical outcome after intravenous thrombolysis (IVT) for acute ischemic stroke than is a small clot (CBS, 7-10). The added benefit of mechanical thrombectomy (MT) might be higher in patients with long clot. The aim of this pre-specified post hoc analysis of the THRombectomie des Artères CErebrales (THRACE) trial was to assess the association between T2*-CBS, successful recanalization and clinical outcome.
Methods Of 414 patients randomized in the THRACE trial, 281 patients were included in this analysis. Associations between T2*-CBS and clinical outcome on the modified Rankin Scale (mRS) at 3 months were tested.
Results High T2*-CBS, i.e., small clot, was associated with a shift toward better outcome on the mRS; proportional odds ratio (POR) per point CBS was 1.19 (95% confidence interval [CI], 1.05 to 1.34) in the whole population, 1.34 (95% CI, 1.13 to 1.59) in IVT group, and 1.04 (95% CI, 0.87 to 1.23) in IVTMT group. After adjustment for baseline prognostic variables, the effect of the full scale T2*-CBS was not statistically significant in the whole population and for the IVTMT group but remains significant for the IVT group (POR, 1.32; 95% CI, 1.11 to 1.58).
Conclusions A small clot, as assessed using T2*-CBS, is associated with improved outcome and may be used as a prognostic marker. Despite the worst outcome with long clot, the relative benefit of MT over IVT seemed to increase with low T2*-CBS and longer clot.
Collapse
Affiliation(s)
- Imad Derraz
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | | | - Marc Soudant
- Department of Biostatistics, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | | | - Wagih Ben Hassen
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Gabriella Hossu
- Department of CIC1433 Innovative Technology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | | | - Anne Laure Derelle
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | - Marie Tisserand
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | - Helene Raoult
- Department of Neuroradiology, CHU Rennes, Rennes, France
| | - Laurence Legrand
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Serge Bracard
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| | - Catherine Oppenheim
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | - Olivier Naggara
- Paris Descartes University, INSERM UMR 894 and Department of Neuroradiology, Sainte-Anne Hospital Center, Paris, France
| | -
- Department of Neuroradiology, CHRU Nancy, INSERM, University of Lorraine, Nancy, France
| |
Collapse
|
32
|
Bourcier R, Pautre R, Mirza M, Castets C, Darcourt J, Labreuche J, Detraz L, Desal H, Serfaty JM, Toquet C. MRI Quantitative T2* Mapping to Predict Dominant Composition of In Vitro Thrombus. AJNR Am J Neuroradiol 2019; 40:59-64. [PMID: 30635330 DOI: 10.3174/ajnr.a5938] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging quantitative T2* mapping, which provides information about thrombus composition and specifically the red blood cell content, may be obtained in the setting of acute ischemic stroke before treatment. This could be useful to adapt the endovascular strategy. We aimed to analyze the red blood cell content of in vitro thrombi in relation to the thrombus-T2* relaxation time. MATERIALS AND METHODS Thirty-five thrombus analogs of different compositions were scanned with an MR imaging quantitative T2* mapping sequence. Two radiologists, blinded to thrombus composition, measured the thrombus-T2* relaxation time twice at an interval of 2 weeks. Quantitative histologic evaluations of red blood cell content were performed. Inter- and intraobserver reproducibility of the thrombus-T2* relaxation time was assessed by calculating intraclass correlation coefficients. Finally, a Spearman product moment correlation between the thrombus-T2* relaxation time and red blood cell content was performed. RESULTS The median thrombus-T2* relaxation time was 78.5 ms (range, 16-268 ms; interquartile range, 60.5 ms). The median red blood cell content was 55% (range, 0%-100%; interquartile range, 75%). Inter- and intraobserver reproducibility of the thrombus-T2* relaxation time was excellent (>0.9). The Spearman rank correlation test found a significant inverse correlation between thrombus-T2* relaxation time and red blood cell content (ρ = -0.834, P < .001). CONCLUSIONS MR imaging quantitative T2* mapping can reliably identify the thrombus red blood cell content in vitro. This fast, easy-to-use sequence could be implemented in routine practice to predict stroke etiology and adapt devices or techniques for endovascular treatment of acute ischemic stroke.
Collapse
Affiliation(s)
- R Bourcier
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.) romain.bourcier@chu-nantes
| | - R Pautre
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.)
| | - M Mirza
- Neuravi Thromboembolic Initiative (M.M.), Galway, Ireland
| | - C Castets
- Siemens Healthineers France (C.C.), Saint-Denis, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J Labreuche
- Department of Biostatistics (J.L.), Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - L Detraz
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.)
| | - H Desal
- From the Departments of Neuroradiology (R.B., R.P., L.D., H.D.)
| | - J-M Serfaty
- Cardiac and Vascular Imaging (J.-M.S.), Hôpital René et Guillaume Laennec, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - C Toquet
- Department of Pathology (C.T.), Hôtel Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
| |
Collapse
|
33
|
Bourcier R, Legrand L, Soize S, Labreuche J, Beaumont M, Desal H, Derraz I, Bracard S, Oppenheim C, Naggara O. Validation of overestimation ratio and TL-SVS as imaging biomarker of cardioembolic stroke and time from onset to MRI. Eur Radiol 2018; 29:2624-2631. [PMID: 30421018 DOI: 10.1007/s00330-018-5835-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to determine in the "THRACE" trial, the clinical and MRI technical parameters associated with the two-layered susceptibility vessel sign (TL-SVS) and the overestimation ratio (overR). MATERIALS AND METHODS Patients with pre-treatment brain gradient echo (GRE) sequence and an etiological work-up were identified. Two readers reviewed TL-SVS, i.e., a SVS with a linear low-intense signal core surrounded by a higher intensity and measured the overR as the width of SVS divided by the width of the artery. Binomial and ordinal logistic regression respectively tested the association between TL-SVS and quartiles of overR with patient characteristics, cardioembolic stroke (CES), time from onset to imaging, and GRE sequence parameters (inter slice gap, slice thickness, echo time, flip angle, voxel size, and field strength). RESULTS Among 258 included patients, 102 patients were examined by 3 Tesla MRI and 156 by 1.5 Tesla MRI. Intra- and inter-reader agreements for quartiles of overR and TL-SVS were good to excellent. The median overR was 1.59 (IQR, 1.30 to 1.86). TL-SVS was present in 101 patients (39.2%, 95%CI, 33.1 to 45.1%). In multivariate analysis, only CES was associated with overR quartiles (OR, 1.83; 95%CI, 1.11 to 2.99), and every 60 min increase from onset to MRI time was associated with TL-SVS (OR, 1.72; 95%CI, 1.10 to 2.67). MRI technical parameters were statistically associated with neither overR nor TL-SVS. CONCLUSION Independent of GRE sequence parameters, an increased overR was associated to CES, while the TL-SVS is independently related to a longer time from onset to MRI. KEY POINTS • An imaging biomarker would be useful to predict the etiology of stroke in order to adapt secondary prevention of stroke. • The two-layered susceptibility vessel sign and the overestimation ratio are paramagnetic effect derived markers that vary according to the MRI machines and sequence parameters. • Independent of sequence parameters, an increased overestimation ratio was associated to cardioembolic stroke, while the two-layered susceptibility vessel sign is independently related to a longer time from onset to MRI.
Collapse
Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Sébastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR-S 1237 Physiopathology and imaging of neurological disorders, Université Caen Normandie, Caen, France
| | - Julien Labreuche
- Centre Hospitalier Regional Universitaire de Lille, Biostatistics, Lille, Hauts-de-France, France
| | - Marine Beaumont
- CIC1433, INSERM, IADI, U1254, Université de Lorraine, INSERM, CHRU de Nancy CIC-IT Nancy, Nancy, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, Hopital Gui de Chauillac, Montpellier, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France.,Pediatric Radiology Department, Necker Enfants Malades, Paris, France
| | | |
Collapse
|
34
|
Ko HC, Ryu CW, Yun SJ, Koh JS, Shin HS, Kim EJ. Characteristic Signs on T2*-Based Imaging and Their Relationship with Results of Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Evidence to Date. Neurointervention 2018; 13:90-99. [PMID: 30196679 PMCID: PMC6132033 DOI: 10.5469/neuroint.2018.01039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Characteristic signs - the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) - on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy. MATERIALS AND METHODS We searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed. RESULTS Nine studies on the SVS and six studies on the PHVS were included. The pooled odds ratio (OR) of recanalization after intravenous thrombolysis or mechanical thrombectomy was not significantly different with the presence of SVS (OR, 0.615; 95% confidence interval [CI], 0.335-1.131 and OR, 0.993; 95% CI, 0.629-1.567). The OR of favorable functional outcome after reperfusion therapy in terms of the presence of PHVS varied (0.083 to 1.831) by study. CONCLUSION Our meta-analysis of the published data showed that a SVS was not a predictive factor for recanalization after reperfusion therapy for acute ischemic stroke. Currently, the data available on T2*MRI are too limited to warrant reperfusion therapy in routine practice. More data are needed from studies with randomized treatment allocation to determine the role of T2*MRI.
Collapse
Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
35
|
Bourcier R, Hassen WB, Soize S, Roux P, Labreuche J, Kyheng M, Tisserand M, Rosso C, Blanc R, Piotin M, Derraz I, Boulouis G, Oppenheim C, Desal H, Bracard S, Lapergue B, Naggara O. Susceptibility vessel sign on MRI predicts better clinical outcome in patients with anterior circulation acute stroke treated with stent retriever as first-line strategy. J Neurointerv Surg 2018; 11:328-333. [PMID: 30154254 DOI: 10.1136/neurintsurg-2018-014217] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Susceptibility vessel sign (SVS) can be a useful MRI biomarker of an occlusion but its relationship with clinical outcomes of acute ischemic stroke (AIS) is yet to be fully elucidated. OBJECTIVE To investigate SVS in relation to the clinical outcomes after mechanical thrombectomy using a stent retriever (SR) as first-line approach in patients with AIS. MATERIAL AND METHODS We included patients with a first-line SR approach for anterior AIS from the the Contact Aspiration vs Stent Retriever for Successful Revascularization (ASTER) and THRombectomie des Artères CErebrales (THRACE) trials when both baseline imaging of SVS and 90-day modified Rankin Scale (mRS) scores were available. Patients were assigned to two groups based on the presence of an SVS (independent core laboratory), and the overall distributions of the mRS score at 90 days (shift analysis) and clinical independence (mRS score ≤2) were compared. RESULTS 217 patients were included and SVS was diagnosed in 76.0% of cases (n=165, 95% CI 70.4% to 81.7%). After adjustment for potential confounders, SVS+ was significantly associated with 90-day mRS improvement (adjusted common OR=2.75; 95% CI 1.44 to 5.26) and favorable outcome (adjusted common OR=2.76; 95% CI 1.18 to 6.45). CONCLUSION Based on results for patients of the ASTER and THRACE trials receiving first-line SR treatment, SVS was associated with lower disability at 3 months. Large prospective studies using MRI-based thrombus evaluation are warranted.
Collapse
Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | | | - Sébastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR
| | - Pascal Roux
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
| | - Maeva Kyheng
- Department of Biostatistics, University Lille, CHU Lille, EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Lille, France
| | - Marie Tisserand
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Charlotte Rosso
- Urgences cérébro-vasculaires, Sorbonne Université, UPMC Univ Paris 06, Hôpital Pitié
| | - Raphael Blanc
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Michel Piotin
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | | | | | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Bertrand Lapergue
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | | | | |
Collapse
|
36
|
Al-Zghloul M, Wenz H, Maros M, Böhme J, Groden C, Förster A. Susceptibility Vessel Sign on T2*-Weighted Gradient Echo Imaging in Lacunar Infarction. In Vivo 2018; 32:973-976. [PMID: 29936488 DOI: 10.21873/invivo.11337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In stroke due to large vessel occlusion, thrombotic material can be demonstrated by the susceptibility vessel sign (SVS), a hypointense signal on T2*-weighted gradient echo magnetic resonance (GRE) images. In the present study, we evaluated the value of GRE for the detection of perforating artery occlusion in hyperacute lacunar infarction (LI). MATERIALS AND METHODS The presence of SVS on GRE in 58 patients with LI who underwent magnetic resonance imaging within 24 hours after symptom onset was analyzed. RESULTS On diffusion-weighted images (DWI), LI was found in the basal ganglia in 17.2%, internal capsule in 25.9%, corona radiata in 19.0%, thalamus in 32.8%, and brainstem in 5.2%. On GRE a subtle circumscribed hypointense signal at the lower edge of the LI consistent with SVS was detected in 11/58 (19%) patients. Patients with SVS had larger ischemic lesions on DWI (p=0.045). CONCLUSION SVS on GRE may be useful for detection of perforating artery occlusion in a subset of patients with hyperacute LI.
Collapse
Affiliation(s)
- Mansour Al-Zghloul
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Máté Maros
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Böhme
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
37
|
Bourcier R, Derraz I, Delasalle B, Beaumont M, Soize S, Legrand L, Desal H, Bracard S, Naggara O, Oppenheim C. Susceptibility Vessel Sign and Cardioembolic Etiology in the THRACE Trial. Clin Neuroradiol 2018; 29:685-692. [PMID: 29947813 DOI: 10.1007/s00062-018-0699-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE The susceptibility vessel sign (SVS) has been described on gradient echo (GRE) magnetic resonance imaging (MRI) in acute ischemic stroke patients by large vessel occlusion. The presence of SVS (SVS+) was associated with treatment outcome and stroke etiology with conflicting results. Based on multicenter data from the THRombectomie des Artères CErebrales (THRACE) study, we aimed to determine if the association between SVS and cardioembolic etiology (CE) was independent of GRE sequence parameters. MATERIAL AND METHODS Patients with a pretreatment brain GRE sequence were identified. Logistic regression tested the association between SVS+, CE, time from onset to imaging and GRE sequence parameters (e.g. echo time, voxel size, field strength). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the SVS to predict a stroke from a CE. RESULTS An SVS+ was observed in 237 out of 287 (83%) patients. In the univariate analysis, there was a significant association between SVS+ and a CE with an odds ratio (OR) and 95% confidence interval (95% CI) of 2.10 (1.02-4.29), respectively (p = 0.04) but not with GRE sequence parameters. In multivariate analysis, there was an independent relationship between SVS+ and CE (OR [95% CI]: 2.14 [1.02-4.45], p = 0.04). Sensitivity and specificity of SVS+ to predict CE were 0.89 and 0.21, respectively. The PPV and NPV of SVS+ were 0.44 and 0.78, respectively. CONCLUSION The presence of SVS is associated to CE, independent of GRE sequence parameters. While the specificity and the PPV of the sign were low, CE seems less likely in the absence of an SVS.
Collapse
Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Béatrice Delasalle
- L'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France.,UMR1087, Institut National de la Santé et de la Recherche Médicale, Nantes, France
| | - Marine Beaumont
- CIC1433, INSERM, Université de Lorraine, Nancy, France.,IADI, U1254, Université de Lorraine, Nancy, France.,CHRU de Nancy CIC-IT, INSERM, Nancy, France
| | - Sebastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR-S 1237 Physiopathology and imaging of neurological disorders, Université Caen Normandie, Caen, France
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,Pediatric Radiology Department, Necker Enfants Malades, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | | |
Collapse
|
38
|
Bourcier R, Mazighi M, Labreuche J, Fahed R, Blanc R, Gory B, Duhamel A, Marnat G, Saleme S, Costalat V, Bracard S, Desal H, Consoli A, Piotin M, Lapergue B. Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration. J Stroke 2018; 20:268-276. [PMID: 29886714 PMCID: PMC6007297 DOI: 10.5853/jos.2018.00192] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/04/2018] [Accepted: 05/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results.
Methods We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (–) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days.
Results Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (–) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (–); P for interaction=0.038).
Conclusions As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.
Collapse
Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Mickael Mazighi
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Julien Labreuche
- Department of Biostatistics, University Lille, CHRU Lille, Lille, France
| | - Robert Fahed
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Raphael Blanc
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Alain Duhamel
- Department of Biostatistics, University Lille, CHRU Lille, Lille, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Suzana Saleme
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Vincent Costalat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Arturo Consoli
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Michel Piotin
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Bertrand Lapergue
- Department of Stroke Center and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | | |
Collapse
|
39
|
Lee WJ, Jung KH, Ryu YJ, Kim JM, Lee ST, Chu K, Kim M, Lee SK, Sohn CH, Roh JK. Impact of stroke mechanism in acute basilar occlusion with reperfusion therapy. Ann Clin Transl Neurol 2018; 5:357-368. [PMID: 29560380 PMCID: PMC5846447 DOI: 10.1002/acn3.536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 12/30/2017] [Indexed: 12/27/2022] Open
Abstract
Objective We aimed to evaluate the impact of underlying mechanism of basilar artery (BA) occlusion on the outcomes after endovascular therapy (EVT) for reperfusion and the outcome factors associated with each mechanism, and to identify radiologic parameters enabling to distinguish the underlying mechanism. Methods From a registry database, 194 consecutive patients with acute BA occlusion who underwent EVT were analyzed. Stroke mechanism, classified into in situ atherosclerotic thrombosis (ISAT) and embolism, clot sign location profiles in pre‐angiography magnetic resonance image (MRI), parameters of angiography and EVT, and reperfusion were assessed. Poor outcome was defined as a modified Rankin‐Scale score at 90 days of 3–6. Results The mean age was 68.8±11.8 years (range 21–92 years) and seventy‐eight (40.2%) were female patients. 102 (52.6%) patients were classified into an embolism mechanism and 92 (47.4%) into an ISAT mechanism. Overall, ISAT mechanism compared with embolism was significantly associated with poor outcomes (P = 0.002), along with the NIHSS scores, reperfusion status, and collateral status. In the embolism group, reperfusion (P = 0.001), NIHSS scores (P < 0.001), and onset‐to‐treatment time (P = 0.030) were significant outcome factors. However, in the ISAT group, baseline collateral status (P = 0.001) and NIHSS scores (P < 0.001) were significant outcome factors. A clot sign at the distal BA segment on pre‐angiography MRI was strongly associated with embolism mechanism (P < 0.001). Interpretation Stroke mechanism has a major influence on outcomes, and outcome predictors differ according to the underlying mechanism in acute BA occlusion with EVT. Clot sign profile on pre‐angiography MRI might be useful to determine the underlying mechanism.
Collapse
Affiliation(s)
- Woo-Jin Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Keun-Hwa Jung
- Department of Neurology Seoul National University Hospital Seoul South Korea.,Program in Neuroscience Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University Seoul South Korea
| | - Young Jin Ryu
- Department of Radiology Seoul National University Hospital Seoul South Korea
| | - Jeong-Min Kim
- Department of Neurology Chung-Ang University Hospital Seoul South Korea
| | - Soon-Tae Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea.,Program in Neuroscience Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University Seoul South Korea
| | - Kon Chu
- Department of Neurology Seoul National University Hospital Seoul South Korea.,Program in Neuroscience Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University Seoul South Korea
| | - Manho Kim
- Department of Neurology Seoul National University Hospital Seoul South Korea.,Program in Neuroscience Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University Seoul South Korea
| | - Sang Kun Lee
- Department of Neurology Seoul National University Hospital Seoul South Korea.,Program in Neuroscience Neuroscience Research Institute of SNUMRC College of Medicine Seoul National University Seoul South Korea
| | - Chul-Ho Sohn
- Department of Radiology Seoul National University Hospital Seoul South Korea
| | - Jae-Kyu Roh
- Department of Neurology Seoul National University Hospital Seoul South Korea.,Department of Neurology Armed Forces Capital Hospital Sungnam South Korea
| |
Collapse
|
40
|
Predictive value of thrombus volume for recanalization in stent retriever thrombectomy. Sci Rep 2017; 7:15938. [PMID: 29162921 PMCID: PMC5698357 DOI: 10.1038/s41598-017-16274-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/09/2017] [Indexed: 12/16/2022] Open
Abstract
This retrospective study investigated whether the volume or density of the thrombus is predictive of recanalization in stent retriever (SR) treatment. Consecutive patients treated with SR thrombectomy as the first endovascular modality were enrolled. The thrombus volume and density were measured on thin-section noncontrast computed tomography using 3-dimensional software. The patients were grouped by recanalization status and the number of SR passes. Among 165 patients, recanalization was achieved with the first pass in 68 (50.0%), 2–3 passes in 43 (31.6%), and ≥4 passes in 25 (18.4%) patients. The thrombus volume was smaller in patients with (107.5 mm3) than without (173.7 mm3, p = 0.025) recanalization, and tended to be larger with increasing number of passes (p for trend = 0.001). The thrombus volume was an independent predictor of first-pass recanalization (odds ratio 0.93 per 10 mm3, 95% confidence interval 0.89–0.97). However, the thrombus density was not associated with recanalization success. Recanalization within 3 passes was associated with a favorable outcome. In conclusion, the thrombus volume was significantly related to recanalization in SR thrombectomy. Measuring the thrombus volume was particularly predictive of first-pass recanalization, which was associated with a higher likelihood of a favorable outcome.
Collapse
|
41
|
Ganeshan R, Nave AH, Scheitz JF, Schindlbeck KA, Haeusler KG, Nolte CH, Villringer K, Fiebach JB. Assessment of thrombus length in acute ischemic stroke by post-contrast magnetic resonance angiography. J Neurointerv Surg 2017; 10:756-760. [PMID: 29151041 DOI: 10.1136/neurintsurg-2017-013454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Post-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different intracranial vessels. METHODS Patients with MRI-confirmed ischemic stroke and intracranial artery occlusion within 24 hours of symptom onset were prospectively evaluated. PC-MRA was added to a standard stroke MRI protocol. Thrombus length was measured on thick slab maximum intensity projection images. Clinical outcome at hospital discharge was assessed by modified Rankin Scale (mRS). RESULTS Thirty-four patients (median age 72 years) presenting with a median National Institutes of Health Stroke Scale score of 11 and a median onset to imaging time of 116 min were included. PC-MRA enabled precise depiction of proximal and distal terminus of the thrombus in 31 patients (91%), whereas in three patients (9%) PC-MRA presented a partial occlusion. Median thrombus length in patients with complete occlusion was 9.9 mm. In patients with poor outcome (mRS ≥3) median thrombus length was significantly longer than in those with good outcome (mRS ≤2;P=0.011). CONCLUSIONS PC-MRA demonstrates intra-arterial thrombus length at different vessel occlusion sites. Longer thrombus length is associated with poor clinical outcome. CLINICAL TRIAL REGISTRATION NCT02077582; Results.
Collapse
Affiliation(s)
- Ramanan Ganeshan
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander H Nave
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jan F Scheitz
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Katharina A Schindlbeck
- Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christian H Nolte
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kersten Villringer
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
42
|
Clinical implications of CT hyperdense artery sign in patients with acute middle cerebral artery occlusion in the era of modern mechanical thrombectomy. J Neurol 2017; 264:2450-2456. [PMID: 29075836 DOI: 10.1007/s00415-017-8655-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 12/28/2022]
Abstract
The clinical implications of the CT hyperdense artery sign have yet to be established in the new era of modern mechanical thrombectomy. This study aimed to investigate prognostic implications of the CT hyperdense middle cerebral artery sign (HMCAS) on treatment outcomes after mechanical thrombectomy for acute MCA occlusions. A retrospective analysis of CT and clinical data from 212 patients with acute MCA occlusions who underwent mechanical thrombectomy was conducted. HMCAS was determined with visual assessment by consensus of two readers. Interobserver agreement was measured. HMCAS was classified into two groups: M1 and M2 HMCAS. Associations between HMCAS and vascular risk factors, stroke etiology, and treatment outcomes were analyzed. Of 212 patients, HMCAS was identified in 118 patients (55.7%). Overall, successful reperfusion was achieved in 82.5% (175/212) and a good outcome in 45.8% (97/212). There was no significant association between HMCAS and treatment outcomes after mechanical thrombectomy, regardless of HMCAS location. Cardioembolism was more frequent in patients with a positive HMCAS (67.8 vs 48.9%, P = 0.005). Large-artery atherosclerosis was more frequent in patients with a negative HMCAS (31.9 vs 12.7%, P = 0.001). Underlying severe MCA stenosis was more frequently observed in patients with a negative HMCAS (25.5 vs 3.4%, P < 0.001). Our study suggests that the prognostic implication of a HMCAS in predicting outcomes after endovascular therapy in patients with acute MCA occlusion may be low in the era of modern mechanical thrombectomy. Negative HMCAS is predictive of in situ thrombotic occlusion due to underlying severe atherosclerotic stenosis in such patients.
Collapse
|
43
|
Liu H, Mei W, Huang Y, Li Y, Chen Z, Li D, Ye H, Zhang J. Susceptibility vessel sign predicts poor clinical outcome for acute stroke patients untreated by thrombolysis. Exp Ther Med 2017; 14:5207-5213. [PMID: 29201238 DOI: 10.3892/etm.2017.5195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/02/2017] [Indexed: 12/13/2022] Open
Abstract
The location and length of the susceptibility vessel sign (SVS) predicts poor outcome for patients having received reperfusion therapy. The aim of the present study was to assess the predictive value of SVS regarding the clinical outcome for patients untreated with thrombolysis. A retrospective study on acute stroke patients who underwent multimodal magnetic resonance imaging within 3 days from the onset of symptoms was performed. None of the patients had received thrombolysis therapy. The presence, location and length of the SVS were assessed. Uni- and multivariate analyses were used to examine the association between SVS and clinical outcome. A total of 43 SVS+ and 73 SVS- patients were included in the study. A modified Rankin Scale (mRS) of ≤2 at 3 months was determined in 41.9% of patients in the SVS+ group and 79.4% in the SVS- group (P<0.001). Multivariate analysis revealed that the presence of SVS was an independent parameter to predict mRS >2 at 3 months (odds ratio, 3.390; 95% confidence interval, 1.122-10.240; P=0.030). For patients with SVS+ status, the location and length of the SVS were not independent predictors of the clinical outcome. In conclusion, the presence of SVS may predict poor clinical outcome for acute stroke patients untreated with thrombolysis.
Collapse
Affiliation(s)
- Huiqin Liu
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Wenli Mei
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yue Huang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yongli Li
- Department of Radiology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Zuzhi Chen
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Dongdong Li
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453100, P.R. China
| | - Hong Ye
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Jiewen Zhang
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| |
Collapse
|
44
|
Bourcier R, Détraz L, Serfaty JM, Delasalle BG, Mirza M, Derraz I, Toulgoat F, Naggara O, Toquet C, Desal H. MRI Interscanner Agreement of the Association between the Susceptibility Vessel Sign and Histologic Composition of Thrombi. J Neuroimaging 2017; 27:577-582. [DOI: 10.1111/jon.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Romain Bourcier
- Department of Neuroradiology, CHU de Nantes; Hôpital René et Guillaume Laennec; Saint Herblain France
| | - Lili Détraz
- Department of Neuroradiology, CHU de Nantes; Hôpital René et Guillaume Laennec; Saint Herblain France
| | - Jean Michel Serfaty
- CHU de Nantes, Hôpital René et Guillaume Laennec; Imagerie Cardiaque et Vasculaire; Nantes France
- Institut Nationale de la Santé et de la Recherche Médicale, UMR 1087; l'institut du thorax; Paris France
| | - Beatrice Guyomarch Delasalle
- CHU de Nantes, Hôpital René et Guillaume Laennec, L'institut du thorax, INSERM, CNRS; UNIV Nantes; Nantes France
| | | | - Imad Derraz
- Department of Neuroradiology; CHU de Nancy; Nancy France
| | - Frédérique Toulgoat
- Central Department of Radiology and Medical Imaging, CHU de Nantes; Hôtel Dieu; Nantes France
| | - Olivier Naggara
- Department of Neuroradiology; Centre Hospitalier Sainte-Anne
- Université Paris-Descartes; INSERM U 894 Paris France
| | - Claire Toquet
- Department of Pathology, CHU de Nantes; Hôtel Dieu; Nantes France
| | - Hubert Desal
- Department of Neuroradiology, CHU de Nantes; Hôpital René et Guillaume Laennec; Saint Herblain France
| |
Collapse
|
45
|
Brinjikji W, Duffy S, Burrows A, Hacke W, Liebeskind D, Majoie CBLM, Dippel DWJ, Siddiqui AH, Khatri P, Baxter B, Nogeuira R, Gounis M, Jovin T, Kallmes DF. Correlation of imaging and histopathology of thrombi in acute ischemic stroke with etiology and outcome: a systematic review. J Neurointerv Surg 2017; 9:529-534. [PMID: 27166383 PMCID: PMC6697418 DOI: 10.1136/neurintsurg-2016-012391] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/15/2016] [Accepted: 04/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Studying the imaging and histopathologic characteristics of thrombi in ischemic stroke could provide insights into stroke etiology and ideal treatment strategies. We conducted a systematic review of imaging and histologic characteristics of thrombi in acute ischemic stroke. MATERIALS AND METHODS We identified all studies published between January 2005 and December 2015 that reported findings related to histologic and/or imaging characteristics of thrombi in acute ischemic stroke secondary to large vessel occlusion. The five outcomes examined in this study were (1) association between histologic composition of thrombi and stroke etiology; (2) association between histologic composition of thrombi and angiographic outcomes; (3) association between thrombi imaging and histologic characteristics; (4) association between thrombi imaging characteristics and angiographic outcomes; and (5) association between imaging characteristics of thrombi and stroke etiology. A meta-analysis was performed using a random effects model. RESULTS There was no significant difference in the proportion of red blood cell (RBC)-rich thrombi between cardioembolic and large artery atherosclerosis etiologies (OR 1.62, 95% CI 0.1 to 28.0, p=0.63). Patients with a hyperdense artery sign had a higher odds of having RBC-rich thrombi than those without a hyperdense artery sign (OR 9.0, 95% CI 2.6 to 31.2, p<0.01). Patients with a good angiographic outcome had a mean thrombus Hounsfield unit (HU) of 55.1±3.1 compared with a mean HU of 48.4±1.9 for patients with a poor angiographic outcome (mean standard difference 6.5, 95% CI 2.7 to 10.2, p<0.001). There was no association between imaging characteristics and stroke etiology (OR 1.13, 95% CI 0.32 to 4.00, p=0.85). CONCLUSIONS The hyperdense artery sign is associated with RBC-rich thrombi and improved recanalization rates. However, there was no association between the histopathological characteristics of thrombi and stroke etiology and angiographic outcomes.
Collapse
Affiliation(s)
| | - Sharon Duffy
- Department of Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Anthony Burrows
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - David Liebeskind
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Charles B L M Majoie
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Adnan H Siddiqui
- Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA
| | - Pooja Khatri
- Department of Neurology, University of Cincinatti, Cincinatti, Ohio, USA
| | - Blaise Baxter
- Department of Radiology, University of Tennessee Medical Center, Chatanooga, Tennessee, USA
| | - Raul Nogeuira
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Matt Gounis
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA
| | - Tudor Jovin
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
46
|
Bourcier R, Brecheteau N, Costalat V, Daumas-Duport B, Guyomarch-Delasalle B, Desal H, Naggara O, Serfaty JM. MRI quantitative T2* mapping on thrombus to predict recanalization after endovascular treatment for acute anterior ischemic stroke. J Neuroradiol 2017; 44:241-246. [PMID: 28478114 DOI: 10.1016/j.neurad.2017.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/13/2017] [Accepted: 03/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In anterior acute ischemic stroke (AAIS) treated with endovascular treatment (EVT), the susceptibility vessel sign (SVS+ or SVS-) is related to recanalization results (TICI 2b/3) and clinical outcome. However, a binary qualitative assessment of thrombus using SVS does not reflect its complex composition. Our aim was to assess whether a quantitative MRI marker, Thrombus-T2* relaxation time, may be assessable in clinical routine and may to predict early successful recanalization after EVT, defined as a TICI 2b/3 recanalization obtained in 2 attempts or less. MATERIAL AND METHODS Thrombus-T2* relaxation time was prospectively obtained from consecutive AAIS patients treated by EVT (concomitant aspiration and stent retriever). Quantitative values were compared between early recanalization and late or unsuccessful recanalization. RESULTS Thirty patients with AAIS were included and Thrombus-T2* relaxation time was obtained in all patients. Earlier TICI 2b/3 recanalization were obtained in 22 patients (73%) and was significantly associated with SVS+ (1/8 vs. 16/22, P=0.01) and a shorter Thombus-T2* relaxation time (mean SD, range: 257, 18-50ms vs. 45 9, 35-60ms, P<0.001). CONCLUSION A new quantitative MRI biomarker, the Thrombus-T2* relaxation time is assessable in clinical routine. In a preliminary study of 30 patients, a shorter Thombus-T2* relaxation time is related to earlier recanalization after EVT using combination of stent retriever and aspiration.
Collapse
Affiliation(s)
- R Bourcier
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France
| | - N Brecheteau
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France.
| | - V Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire, Montpellier, France
| | - B Daumas-Duport
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France
| | - B Guyomarch-Delasalle
- Centre Hospitalier Universitaire Nantes Hôpital G et R Laënnec, Nantes, France; Centre d'investigation clinique Thorax, l'institut du thorax, Nantes, France; Centre national de la recherche scientifique, 75016 Paris, France
| | - H Desal
- Departments of Diagnostic and Interventional Neuroradiology of the University Hospital of Nantes, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France; Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France
| | - O Naggara
- Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Centre Hospitalier Sainte-Anne, Paris, France
| | - J M Serfaty
- Institut National de la Santé et de la Recherche Médicale, UMR1087, 44000 Nantes, France; Departments of Diagnostic Cardiac and Vascular Imaging, l'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France
| |
Collapse
|
47
|
Kang DW, Jeong HG, Kim DY, Yang W, Lee SH. Prediction of Stroke Subtype and Recanalization Using Susceptibility Vessel Sign on Susceptibility-Weighted Magnetic Resonance Imaging. Stroke 2017; 48:1554-1559. [PMID: 28432264 PMCID: PMC5436734 DOI: 10.1161/strokeaha.116.016217] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/20/2017] [Accepted: 03/14/2017] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The susceptibility vessel sign (SVS) is a hypointense signal visualized because of the susceptibility effect of thrombi, sensitively detected on susceptibility-weighted magnetic resonance imaging. The relationship of SVS parameters with the stroke subtype and recanalization status after endovascular treatment remains uncertain. Methods— The data from 89 patients with acute stroke caused by anterior circulation infarcts who underwent susceptibility-weighted magnetic resonance imaging before endovascular treatment were examined. Independent reviewers, blinded to the stroke subtype and recanalization status, measured the SVS diameter, length, and estimated volume. The intra- and interrater agreements of the SVS parameters were assessed. Results— The SVS was identified in 78% of the patients. SVS was more commonly associated with cardioembolism than with noncardioembolism (P=0.01). The SVS diameter (P<0.01) and length (P=0.01) were larger in the cardioembolism group. The SVS diameter was larger in the recanalization group (thrombolysis in cerebral infarction ≥2b) than in the nonrecanalization group (P=0.04). Multivariable analysis revealed that the SVS diameter was an independent predictor of cardioembolism (adjusted odds ratio, 1.97; 95% confidence interval, 1.34–2.90; P<0.01). There was no significant association between the SVS volume and the recanalization status (adjusted odds ratio, 1.003; 95% confidence interval, 0.999–1.006; P=0.12). The optimal cutoff value of the SVS diameter for the cardioembolism was 5.5 mm (sensitivity, 45.6%; specificity, 93.8%). Conclusions— Increased SVS diameter on susceptibility-weighted magnetic resonance imaging may predict cardioembolism. No clear association was found between SVS volume and endovascular recanalization.
Collapse
Affiliation(s)
- Dong-Wan Kang
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Han-Gil Jeong
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Do Yeon Kim
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Wookjin Yang
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Seung-Hoon Lee
- From the Department of Neurology, Seoul National University Hospital, Republic of Korea.
| |
Collapse
|
48
|
Payabvash S, Benson J, Taleb S, Rykken J, Hoffman B, McKinney A, Oswood M. Susceptible vessel sign: identification of arterial occlusion and clinical implications in acute ischaemic stroke. Clin Radiol 2017; 72:116-122. [DOI: 10.1016/j.crad.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
|
49
|
Heo JH, Kim K, Yoo J, Kim YD, Nam HS, Kim EY. Computed Tomography-Based Thrombus Imaging for the Prediction of Recanalization after Reperfusion Therapy in Stroke. J Stroke 2017; 19:40-49. [PMID: 28178411 PMCID: PMC5307933 DOI: 10.5853/jos.2016.01522] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/03/2017] [Accepted: 01/11/2017] [Indexed: 01/24/2023] Open
Abstract
The prediction of successful recanalization following thrombolytic or endovascular treatment may be helpful to determine the strategy of recanalization treatment in acute stroke. Thrombus can be detected using noncontrast computed tomography (CT) as a hyperdense artery sign or blooming artifact on a T2*-weighted gradient-recalled image. The detection of thrombus using CT depends on slice thickness. Thrombus burden can be determined in terms of the length, volume, and clot burden score. The thrombus size can be quantitatively measured on thin-section CT or CT angiography/magnetic resonance angiography. The determination of thrombus size may be predictive of successful recanalization/non-recanalization after intravenous thrombolysis and endovascular treatment. However, cut-offs of thrombus size for predicting recanalization/non-recanalization are different among studies, due to different methods of measurements. Thus, a standardized method to measure the thrombus is necessary for thrombus imaging to be useful and reliable in clinical practice. Software-based measurements may provide a reliable and accurate assessment. The measurement should be easy and rapid to be more widely used in practice, which could be achieved by improvement of the user interface. In addition to prediction of recanalization, sequential measurements of thrombus volume before and after the treatment may also be useful to determine the efficacy of new thrombolytic drugs. This manuscript reviews the diagnosis of thrombus, prediction of recanalization using thrombus imaging, and practical considerations for the measurement of thrombus burden and density on CT.
Collapse
Affiliation(s)
- Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeonsub Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Yeop Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| |
Collapse
|
50
|
Payabvash S, Benson JC, Taleb S, Rykken JB, Hoffman B, Oswood MC, McKinney AM. Prominent cortical and medullary veins on susceptibility-weighted images of acute ischaemic stroke. Br J Radiol 2017; 89:20160714. [PMID: 27805839 DOI: 10.1259/bjr.20160714] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine the clinical and imaging implications of prominent cortical and medullary veins on susceptibility-weighted images (SWI) of patients with acute stroke. METHODS Consecutive patients with acute ischaemic stroke who had SWI scan within 24 h of symptom onset or time last-seen-well were included. The SWI series were reviewed for the presence of prominent cortical and medullary veins and were graded independently by two neuroradiologists. The correlations between prominent vein grades with different imaging and clinical variables were determined. RESULTS Among 213 patients, prominent SWI cortical and medullary veins were identified in 35 (16.4%) patients and 20 (9.4%) patients, respectively. There was fair interobserver agreement (k = 0.314-0.338, p ≤ 0.001) for grading, and moderate agreement (k = 0.406-0.413, p ≤ 0.001) for the presence of prominent veins. Both prominent cortical and medullary veins were associated with the presence of arterial occlusion (rho = 0.232, p = 0.001; rho = 0.180, p = 0.008; respectively) and larger infarct volume (rho = 0.445, p < 0.001; rho = 0.167, p = 0.015; respectively). However, neither cortical nor medullary cortical veins were associated with the severity of symptoms at admission or clinical outcome. Prominent cortical veins were independent predictors of arterial occlusion (p = 0.018), whereas prominent medullary veins were more strongly associated with larger infarct volumes (p < 0.001). CONCLUSION There were small but significant correlations between cortical and medullary veins on SWI with arterial occlusion and large infarct volume in acute ischaemic stroke. Advances in knowledge: In consecutive patients with acute ischaemic stroke within anterior and posterior circulation territories, prominent cortical and medullary veins on SWI series are associated with imaging biomarkers of poor clinical outcome (i.e. large infarct volume and major arterial occlusion).
Collapse
Affiliation(s)
| | - John C Benson
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shayandokht Taleb
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey B Rykken
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin Hoffman
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark C Oswood
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- 1 Department of Radiology, University of Minnesota, Minneapolis, MN, USA.,2 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| |
Collapse
|